Provider Demographics
NPI:1114712148
Name:MITCHELL, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DUCK HILL
Mailing Address - State:MS
Mailing Address - Zip Code:38925-9415
Mailing Address - Country:US
Mailing Address - Phone:662-809-7341
Mailing Address - Fax:
Practice Address - Street 1:2504 BROWNING ROAD 520 # 1505
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6022
Practice Address - Country:US
Practice Address - Phone:662-453-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health